重症患者的代谢表型和维生素D反应:一个代谢组队列研究
Hirotada Kobayashi1, Karin Amrein2, Sherif H Mahmoud3
1Department of Critical Care Medicine, Sunnybrook Health Sciences Center, 2075 Bayview Ave, Toronto, ON M4N 3M5, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, 204 Victoria Street, Toronto, ON M5B 1T8, Canada.
Clinical nutrition (Edinburgh, Scotland)
|September 22, 2024
概括
在重症患者中高剂量维生素D3补充确定了不同的代谢表型. 只有一个表型显示死亡率降低,这表明向的维生素D3治疗可能会改善严重疾病的结果.
科学领域:
- 关键护理医学 关键护理医学
- 代谢学 代谢学 代谢学
- 个性化医疗是个性化的医疗.
背景情况:
- 维生素D缺乏症在重症患者中很普遍.
- 以前对维生素D3补充剂的试验没有显示出明显的益处.
- 确定对维生素D3有反应的患者子组至关重要.
研究的目的:
- 在重症患者中识别出明显的维生素D3响应性代谢表型.
- 使用机器学习分析VITdAL-ICU试验中的代谢学数据.
- 调查这些表型,维生素D3补充剂和死亡率之间的关联.
主要方法:
- 应用共识聚类与围绕 medoids 分区到随机化前的血代谢组数据.
- 使用线性混合效应回归模型来识别表型内的代谢物差异.
- 使用多变量逻辑回归评估了维生素D3和180天死亡率之间的关联.
主要成果:
- 在453名重症成年人中确定了4种不同的代谢表型 (A-D集群).
- 集群D显示分支链氨基酸催化剂,长链甲酸尼和甲酸糖的增加.
- 高剂量的维生素D3与D群中的180天死亡率显著降低相关 (aOR0.28;P=0.03),但在A,B或C群中并非如此.
结论:
- 代谢学数据的聚类揭示了危急病患者的生物学上不同的表型.
- 代谢表型不同地影响了维生素D3与代谢途径和死亡率的关联.
- 这些发现支持进一步研究临界疾病的表型向维生素D3策略.
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